Connecting Race, Place and Health to Equity

1. Connecting Race, Place and Health to Equity Maryland Women’s Coalition for Health Care Reform Conference Mildred Thompson, Director PolicyLink Center for Health Equity and Place September 8, 2012

2. PolicyLink is a national research and action institute advancing economic and social equity by Lifting Up What Works. ®

3. The Center for Health Equity and Place Where you live affects how you live.

4. PolicyLinkCenter for Health Equity and Place • Research • Capacity Building/ TA • Convening • Communications • Advocacy/Action • Thought Leadership

5. Defining Health: Overall state of physical, economic, social and spiritual well-being

6. THE FACE OF AMERICA IS CHANGING

15. Obesity Data/Statistics – United States* • In 2010, African American women were 40% more likely to be obese than Non-Hispanic White women. • Native Hawaiian/Pacific Islanders are 2.7 times more likely to be obese than the overall Asian American population. • In 2007- 2008 Mexican American children, between the ages 6 and 17, were 40% more likely to be overweight as Non- Hispanic White Children. • American Indian/Alaskan Natives are 40 percent more likely to be obese than Non-Hispanic whites. *US Department of Health and Human Services, Office of Minority Health

16. Obesity Data/Statistics – Maryland Maryland obesity statistics* • 2011, Maryland was ranked the 26th most obese state in the US but 15 years ago was ranked the 23rd most obese state. • The overall adult obesity rate in Maryland is now at 27.1% Racial and ethnic categories show • 36.3% obese rates among Blacks, • 27.4% among Latinos, and • 24.3% among Whites Overweight and Obesity Rates for Adults by Gender, 2010** • 59.1% of women in Maryland were overweight or obese in comparison to 57% of women in the United States *reported in F as in Fat from the Trust for America’s Health and Robert Wood Johnson Foundation **Kaiser Family Foundation State Health Facts

17. Health of Women in Maryland* • Heart disease and cancer accounted for nearly half (48%) of all female deaths. • The leading causes of death are the same for both White and Black women (heart disease, cancer, and stroke). • Black women have higher death rates from heart disease than white women. • HIV is the third leading cause of death among black women ages 25-44 years old. *”The Health of Maryland Women 2011", produced by The Center for Maternal and Child Health, Maryland Department of Health and Mental Hygiene (DHMH)

18. Health of Women in Maryland* • More women died from lung cancer than any other cancer. • Cancer mortality rates for women have declined from 2001 to 2009 by nearly 4%. • Death rates from breast cancer were highest for black women than all other race/ethnicities. • Hypertension and diabetes was most prevalent among blacks and women over 65 years of age. *”The Health of Maryland Women 2011", produced by The Center for Maternal and Child Health, Maryland Department of Health and Mental Hygiene (DHMH)

19. Race, Class, Ethnicity and Health African Americans, Hispanics, Native Americans and some Asian Americans suffer poorer health outcomes than whites, regardless of S.E.S.

20. Social Determinants of Health • Poverty, Unemployment • Neighborhood Conditions • Housing • Food Access • Parks, Physical Activity • Safety Concerns • Toxic Environment

21. Making the case for Equity

22. What is Equity? • Equity means just and fair inclusion. • An equitable society is one in which all can participate and prosper. The goals of equity must be to create conditions that allow all to reach their full potential. In short, equity creates a path from hope to change. • Achieving equity requires intentionality, focus, and a commitment to community engagement and participation.

23. Complexity of Health Disparities

24. Health Inequities • Systematic and unjust distribution of social, economic, and environmental conditions needed for health: • Income • Employment • Education • Housing • Access to healthcare

25. Intersection of Health, Place & Equity Health facilities Access to Healthy Food Schools/ Child care Health Housing Community Safety/ violence Environment Equity Parks/OpenSpace playgrounds TransportationTraffic patterns Work environments

26. Parks Grocery Stores Financial Institutions Better Performing Schools Good Public Transportation Vibrant healthy homes Fast Food Restaurants Liquor Stores Unsafe/Limited Parks Poor Performing Schools Increased Pollution and Toxic Waste Sites Limited Public Transportation Increased crime Communities of Opportunity Low- Income Communities Good Health Status • Poor Health Status • Contributes to health disparities: • Obesity • Diabetes • Asthma • Increased injury

27. Equitable Policies • Equity as a criteria for inclusion and/or prioritization of policies • Identify policies that are important to low-income communities, communities of color and other vulnerable populations specifically • Target benefits to vulnerable populations • Prioritize the provision of resources to areas that need it most

28. Equity Considerations in Strategy Development • Is the strategy conceptualized to promote equity/reduce inequities? If so, how? If not, how can you modify it to specifically address inequities? • How will you deliberately focus on implementing this strategy in a way that promotes equity? • How will your strategy promote meaningful and authentic community engagement? • What inequities will be reduced as a result of this strategy? • How have low-income communities and communities of color benefited from implementing this strategy? • Identify barriers and unintended consequences

29. How to Take Action • Ask Key Questions : who benefits, who pays, who decides? • Increase Political Power of Vulnerable Populations, including Immigrants • Enforce Laws that Prohibit discrimination • Shift Public Perceptions • Substantive Community Engagement • Target Policies that Disproportionately Harm Vulnerable Populations

30. Examples of Equity Promoting Policies • Health in all policies • Health Impact Assessments (HIAS) • Healthy Food Access • Transportation Reauthorization • Joint use Agreements • Safe water and safe parks • Healthy Housing Policies • Leveraging federal resources • HFFI (fresh food financing initiatives) • Sustainable Communities • Promise Neighborhoods

31. California FreshWorks Fund (CAFWF) The California FreshWorks Fund (CAFWF) is a public-private partnership loan fund modeled after the Pennsylvania Fresh Food Financing Initiative and aligned with President Obama’s National Healthy Food Financing Initiative (HFFI). It was created to: • Increase access to healthy food in underserved communities • Spur economic development that supports healthy communities • Inspire innovation in healthy food retailing

32. California FreshWorks Fund (CAFWF) Benefits: • Access to Healthier Food • New Jobs • Improved Property Values • Increased Tax Revenue

33. Principles for Community Engagement • Empower residents through meaningful inclusion and partnerships • Buildcapacityfor high level engagement • Prioritize community knowledge and concerns • Target resources to support ongoing engagement • Facilitate mechanisms that encourage mutual learning and feedback mechanisms

34. Towards More Equitable Public Engagement Processes Inclusive: What communities and interests need to be represented and in what capacity? Accessible:Will people and organizations from a diversity of backgrounds feel comfortable and engaged? Transparent:How does public engagement interact and influence decision-making?

35. Engagement and Leadership • Efforts to achieve revitalized communities of opportunity will not be successful without substantial community engagement • Meaningful community engagement requires participation in governance and decision making

36. Community Engagement Context Feedback Share successes & challenges Document Progress Host Convening Issue Identify issue Agree on priority Impact CBPR Create Indicators Monitor & Track Progress Research Analysis & Data Mapping Trends Rates Engaged Community Equity & Improved Health Outcomes Affirm Solutions that work Strengths/Capacity Sustainability Investment Commitment Accountability Persistence Explore Solutions Advocacy Policy System Change Actions Legislative School board Legal Administrative Institutional Barriers Challenges Contribution Perceptions Partners Agencies Policymakers Businesses Schools Churches Communication Message development Spokespersons Media tools & products

37. Institutional Structures for Community Engagement Ascending Impact DescendingImpact

38. Getting Equity Advocacy Results (GEARS)

39. Measuring Health Equity • Measurement of community conditions relevant to health • Measurement of the implementation of strategies, campaigns, policies and plans • Measurement of health behaviors and health outcomes

40. 'Of all the forms of inequality, injustice in health care is the most shocking and most inhumane' - Martin Luther King, Jr. (March 25, 1966)

41. Thank you! Mildred Thompson, Director PolicyLink Center for Health Equity and Place www.PolicyLink.org